COVID-19 pneumonia: high diagnostic accuracy of chest CT in patients with intermediate clinical probability
- PDF / 1,579,436 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 75 Downloads / 218 Views
CHEST
COVID-19 pneumonia: high diagnostic accuracy of chest CT in patients with intermediate clinical probability Anne Laure Brun 1 & Alexia Gence-Breney 1 & Julie Trichereau 2 & Marie Christine Ballester 3 & Marc Vasse 4,5 & Marie Laure Chabi 1 & François Mellot 1 & Philippe A. Grenier 2 Received: 4 June 2020 / Revised: 27 August 2020 / Accepted: 23 September 2020 # European Society of Radiology 2020
Abstract Objectives To assess inter-reader agreements and diagnostic accuracy of chest CT to identify COVID-19 pneumonia in patients with intermediate clinical probability during an acute disease outbreak. Methods From March 20 to April 8, 319 patients (mean age 62.3 years old) consecutive patients with an intermediate clinical probability of COVID-19 pneumonia underwent a chest CT scan. Two independent chest radiologists blinded to clinical information and RT-PCR results retrospectively reviewed and classified images on a 1–5 confidence level scale for COVID19 pneumonia. Agreements between radiologists were assessed with kappa statistics. Diagnostic accuracy of chest CT compared with RT-PCR assay and patient outcomes was measured using receiver operating characteristics (ROC). Positive predictive value (PPV) and negative predictive value (NPV) for COVID-19 pneumonia were calculated. Results Inter-observer agreement for highly probable (kappa: 0.83 [p < .001]) and highly probable or probable (kappa: 0.82 [p < .001]) diagnosis of COVID-19 pneumonia was very good. RT-PCR tests performed in 307 patients were positive in 174 and negative in 133. The areas under the curve (AUC) were 0.94 and 0.92 respectively. With a disease prevalence of 61.2%, PPV were 95.9% and 94.3%, and NPV 84.4% and 77.1%. Conclusion During acute COVID-19 outbreak, chest CT scan may be used for triage of patients with intermediate clinical probability with very good inter-observer agreements and diagnostic accuracy. Key Points • Concordances between two chest radiologists to diagnose or exclude a COVID-19 pneumonia in 319 consecutive patients with intermediate clinical probability were very good (kappa: 0.82; p < .001). • When compared with RT-PCR results and patient outcomes, the diagnostic accuracy of CT to identify COVID-19 pneumonia was high for both radiologists (AUC: 0.94 and 0.92). • With a disease prevalence of 61.2% in the studied population, the positive predictive values of CT for diagnosing COVID-19 pneumonia were 95.9% and 94.3% with negative predictive values of 84.4% and 77.1%. Keywords COVID-19 . Observer variation . Triage . Disease outbreak . ROC curve
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07346-y) contains supplementary material, which is available to authorized users. * Anne Laure Brun [email protected] 1
2
Department of Radiology, Hôpital Foch, 40 rue Worth, 92150 Suresnes, France Department of Clinical Research and Innovation, Hôpital Foch, 40 rue Worth, 92150 Suresnes, France
3
Department of Emergency Medicine, Hôpital Foch, 40 rue Worth, 92150 Sur
Data Loading...
